Cold cellulitis. An unusual presentation of cutaneous leishmaniasis

We describe a case of cutaneous leishmaniasis, which presented as what we call "cold cellulitis". This may be differentiated from classical cellulitis/erysipelas by 1. Lesser local reaction like pain and tenderness 2. No systemic symptoms 3. No leucocytosis 4. Negative bacteriological and serological assay for bacterial cellulitis/erysipelas, 5. Longer course of illness and 6. Failure to respond to antibiotics. However, awareness of this type and frequent skin smears or skin biopsy will settle the right diagnosis. A review of different leishmanial presentations is given for comparison.